1: Hypertension Flashcards
Blood pressure classifications (normal, pre, stage I, stage II)
Normal is <80. Pre: 120-139/ 80-89. I: 140-159/ 90-99. II: 160+/100+
Why is HTN not adequately controlled locally and nationally?
Many pt (access, knowledge, obesity, AE) and MD factors (time, knowledge of guidelines, white coat syndrome belief, time)
How does treatment of HTN change for the elderly?
It shouldn’t. Managing shows significant decrease in death, HF, stroke
Decreasing BP with exertion is a sign of ___
CAD
Currently used HTN meds
Thiazide diuretics, beta-blockers, ACEI, ARB, Ca channel blockers
Most effective HTN meds
All quite similar. At std dose: ARBs lower systolic ~10.3, BB 9.2, Ca and thiazides 8.8, ACEI 8.5
A patient is on the standard dose of a BP med, but BP is still 145 systolic. Best next step?
Add another med. This is generally preferable to increasing dose as it will have a much greater effect.
With combination therapy, which combination is best?
Generally no significant difference between combos
Main benefits of lowering BP
Reduce incidence of: stroke (35-40%), MI (20-25%), HF (50%!!)
African Americans are generally more sensitive to what BP med?
Ca channel blockers
Patients with low renin or who are thin, older, or black would tip you more toward using which meds?
Thiazides, Ca channel blockers, alpha blockers
Patients with high renin, younger, or overweight would tip you more toward using which meds?
BB, ACEI, ARB
NNT for HTN to prevent a death over 2 years
40
Which anti-hypertensive should not be used as monotherapy?
BB. Risk of stroke 16% higher than other drugs (though there’s no diff post MI)
If patients want to treat HTN with lifestyle modifications, how long should you allow them to improve?
3-6 months
What lifestyle factors can decrease BP? (5)
Dec: Na, alcohol, caffeine. Inc aerobic phys activity. Lose weight.
Prevalence of HTN in US elderly 75+
78%
Common causes of resistant HTN (4)
OSA, renal parenchymal disease, primary aldosteronism, renal artery stenosis
Uncommon causes of resistant HTN (5)
Pheochromocytoma, Cushing’s disease, hyperparathyroidism, aortic coarctation, intracranial tumor
What is Cushing’s Syndrome?
Pituitary gland -> inc adrenocorticotropic hormone (ACTH)/ glucocorticoid -> HTN. Caused by tumor or prolonged corticosteroid treatment.
For age 1-10, what is an appropriate BP range?
age 1: 80-90/35-50
age 10: 90-110/50-60
What percent of obese children have pre-HTN or HTN?
30%. Leads to end-organ damage & adult HTN
Normal BP in children is
<90th percentile based on sex, age, height
Pre-HTN in children is
90 to 95th percentile or greater than/ equal to 120/80. Rec lifestyle change
Stage 1 HTN in children is
95 to <99th percentile + 5 mmHg based on sex, age, height. Lifestyle + possible med
Stage 2 HTN in children is
> 99th percentile plus 5mmHg based on sex, age, height. Lifestyle + med management, screen for CV or renal disease
What is the most common cause of secondary HTN? How does it present?
Renovascular HTN. Ischemic loss of renal fx, otherwise unexplained sudden onset pulm edema
Presentation of hyperaldosteronism
HTN, hypoK+. Could have adrenal adenoma, bilateral adrenal hyperplasia
Presentation of pheochromocytoma
Very rare. Episodic HA, sweating, tachycarida. 50% w paroxysmal HTN, 50% “essential”
WIS prehypertension?
20% progresses to HTN per year. 27% inc in all cause mortality, 66% inc in CVD mortality.
How prevalent is pre-HTN
31% in US
Weight reduction can decrease BP by ROUGHLY how much per pound?
1 mmHg/pound
What should you do with a patient with pre-HTN?
Counsel about lifestyle changes and monitor BP closely. Meds not indicated.
